Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Am J Cardiol. 2022 Sep 1;178:72-79. doi: 10.1016/j.amjcard.2022.05.023. Epub 2022 Jun 28.
The 6-minute walk distance (6MWD) carries prognostic value in patients with heart failure with reduced ejection fraction (HFrEF). We performed this systematic review and meta-analysis to evaluate the effect of heart failure therapies on improvement in 6MWD. A systematic search of MEDLINE and Embase was conducted for randomized controlled trials measuring 6MWD at baseline and at follow-up in at least 50 patients with HFrEF across both arms. The primary outcome was improvement in 6MWD at follow-up. Meta-analysis was stratified in groups on the basis of medical therapy, device-based therapy, autonomic modulation, and exercise. Mean differences (MDs) with 95% confidence interval (CI) were reported across multiple studies that were included in the meta-analysis. A total of 44 studies met the inclusion criteria for systematic review; 17 of which were included for meta-analysis. Statistical analysis showed a statistically significant improvement in 6MWD in meters (m) at follow-up for device-based therapy (MD 20.01 m, 95% CI 18.71 to 21.31), autonomic modulation (MD 76.64 m, 95% CI 54.10 to 99.19), and exercise group (MD 39.52 m, 95% CI 19.68 to 59.35). Pooled analysis of medical therapy did not show statistically significant improvement in 6MWD at follow-up (MD 31.69 m, 95% CI -6.52 to 69.91). Device-based therapy (cardiac resynchronization therapy and cardiac contractility modulation), autonomic modulation, and exercise training programs are associated with improvement in 6MWD in patients with HFrEF. 6MWD is a useful test to gauge improvement in functional capacity among patients with HFrEF, especially those with severe symptomatic heart failure.
6 分钟步行距离（6MWD）对射血分数降低的心力衰竭（HFrEF）患者具有预后价值。我们进行了这项系统评价和荟萃分析，以评估心力衰竭治疗对 6MWD 改善的影响。系统检索了 MEDLINE 和 Embase，以查找至少在 HFrEF 患者的双臂中基线和随访时均测量了 6MWD 的随机对照试验。主要结局是随访时 6MWD 的改善。根据药物治疗、基于器械的治疗、自主调节和运动，将荟萃分析分层。在纳入荟萃分析的多项研究中，报告了均值差（MD）及其 95%置信区间（CI）。共有 44 项研究符合系统评价的纳入标准；其中 17 项被纳入荟萃分析。统计分析显示，基于器械的治疗（MD 20.01m，95%CI 18.71 至 21.31）、自主调节（MD 76.64m，95%CI 54.10 至 99.19）和运动组（MD 39.52m，95%CI 19.68 至 59.35）在随访时 6MWD 有统计学显著改善。药物治疗的汇总分析显示，在随访时 6MWD 没有统计学显著改善（MD 31.69m，95%CI-6.52 至 69.91）。基于器械的治疗（心脏再同步治疗和心脏收缩力调节）、自主调节和运动训练方案与 HFrEF 患者 6MWD 的改善相关。6MWD 是评估 HFrEF 患者心功能改善的有用测试，特别是那些有严重症状性心力衰竭的患者。
